Provider Demographics
NPI:1033965413
Name:EXECUTIVE MEDICINE, INC.
Entity Type:Organization
Organization Name:EXECUTIVE MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ULIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SARGEANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-254-4496
Mailing Address - Street 1:PO BOX 2063
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91017-6063
Mailing Address - Country:US
Mailing Address - Phone:877-254-4496
Mailing Address - Fax:877-254-4496
Practice Address - Street 1:1227 BUENA VISTA ST STE F
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-2486
Practice Address - Country:US
Practice Address - Phone:877-254-4496
Practice Address - Fax:877-254-4496
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXECUTIVE MEDICINE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care